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The Somatic Connection  |   October 2014
Dose-Response Research in Chiropractic Care and Possible Comparisons With OMT
Author Affiliations
  • Hollis H. King, DO, PhD
    University of California, San Diego School of Medicine
Article Information
The Somatic Connection   |   October 2014
Dose-Response Research in Chiropractic Care and Possible Comparisons With OMT
The Journal of the American Osteopathic Association, October 2014, Vol. 114, 811-812. doi:10.7556/jaoa.2014.159
The Journal of the American Osteopathic Association, October 2014, Vol. 114, 811-812. doi:10.7556/jaoa.2014.159
Haas M, Vavrek D, Petersen D, Polissar N, Neradilek MB. Dose-response and efficacy of spinal manipulation for care of chronic low back pain: a randomized controlled trial. Spine J. 2014;14(7):1106-1116. doi:10.1016/j.spinee.2013.07.468.  
Chiropractic researchers at the University of Western States in Portland, Oregon, carried out a practice-based randomized controlled trial to assess dose-response and efficacy of spinal manipulative therapy (SMT) for chronic low back pain (LBP). All participants (N=400) had current chronic LBP “of mechanical origin of at least 3 months duration” and some chronic LBP “on 30 days in the previous 6 weeks.” Participants who received manual therapy during the previous 90 days were excluded. 
The SMT intervention was high-velocity, low-amplitude technique to the lumbar and lower thoracic areas. A comparator intervention of focused light massage was used rather than sham SMT because the researchers wanted to avoid participant disappointment if the participant thought he or she was receiving a sham intervention. 
Four groups were identified by dose received: 0, 6, 12, or 18 SMT applications. All participants were seen 18 times, 3 times per week for 6 weeks. For the sessions in which SMT was not applied, focused light massage was administered. The primary outcome measures were the self-reported Van Korff pain and disability scales. Secondary measures were administered regarding pain unpleasantness. Follow-up data were collected for 1 year. 
All groups who received SMT reported a small but statistically significant improvement in both pain and disability, improving by 20 points at 12 weeks compared with the light massage–only group, and these improvements were sustained through 52 weeks. The authors indicated that this finding may not be clinically significant because of the design aspects of the trial. However, regarding the dose-response consideration, 12 SMT sessions in 6 weeks yielded the most favorable pain and functional disability improvement for chronic LBP as compared with the 6- or 18-SMT sessions. 
Although osteopathic research has yet to directly address the dose-response question for osteopathic manipulative treatment (OMT), salient points were made by Licciardone1 in reference to Licciardone et al2 in which comparable pain improvement was achieved at 12 weeks after only 6 OMT sessions. The OMT protocol in Licciardone et al2 was more comprehensive, as it included soft tissue, myofascial release, muscle energy, and counterstrain procedures. 
References
Licciardone JC. Short-term dosing of manual therapies for chronic low back pain [letter]. Spine J. 2014;14(6): 1085-1086. doi:10.1016/j.spinee.2013.12.015. [CrossRef] [PubMed]
Licciardone JC, Minotti DE, Gatchel RJ, Kearns CM, Singh KP. Osteopathic manual treatment and ultrasound therapy for chronic low back pain: a randomized controlled trial. Ann Fam Med. 2013:11(2):122-129. doi:10.1370/afm.1468. [CrossRef] [PubMed]